Prognostic value of immunohistochemical classification of diffuse large B-cell lymphoma into germinal center B-cell and non-germinal center B-cell subtypes

To study the expression of germinal center B-cell [GCB]/activated B-cell like-related proteins to get optimal stratification of diffuse large B-cell lymphoma [DLBCL] patients, and correlate this with the established clinical and laboratory parameters. This study was conducted retrospectively on 30 archival paraffin tissue blocks of DLBCL. All patients were diagnosed between April 2004 and January 2007 at Ain Shams University Hospital and National Cancer Institute, Cairo, Egypt. All patients received anthracycline-based regimens, and none of them received rituximab immunotherapy. Each case included in this study was investigated by immunohistochemical reaction for multiple myeloma-1/ interferon regulatory factor-4, B-cell/lymphoma 6, and cluster of differentiation 10 monoclonal antibodies. Patients were classified as GCB group [17 patients] and non-GGB group [13 patients]. We found a statistically significant association between non-GCB phenotype and performance status [PS] >1, high lactate dehydrogenase [LDH] level, advanced international prognostic index [IPI], and poor patient outcome. Non-GCB phenotype, high LDH level, and PS>1 were all associated with increased mortality risk. The median survival time was 46.9 months in group A compared to 19.6 months in group B [hazard ratio [HR]=3.30; 95% confidence interval [CI]=0.52-21.10]. Using multivariate Cox regression analysis, non-GCB phenotype was found to be the most predicting factor [HR=6.07; 95% CI=1.6-22.9; p=0.008]. The subclassification of DLBCL into GCB and non-GCB groups using immunohistochemistry may be useful for identifying those patients whose prognosis is so poor that more aggressive therapy can be given at the time of diagnosis

Treatment of favorable, early-stage hodgkin's disease in children and adolescents using vamp and low-dose, involved-field radiation

to evaluate outcome and assess, toxicity of children and adolescents with, early-stage, favorable Hodgkin's disease treated with vinblastine, doxorubicin, methotrexate, and prednisone [VAMP] and low-dose, involved-field radiation, Patients and twenty-four patients with clinical stages I and IIA, favorable [nonbulky] Hodgkin's disease were treated with four cycles of VAMP chemotherapy and 15Gy involved field radiation for those who achieved a complete response, or 25.5Gy for those who achieved a partial response to two cycles of VAMP with a median follow-up of 49 months [range, 74 to 66 months], the overall and event-free survival were 95.8% and 87.5%, respectively. The only factor associated with longer event-free survival was the number of initially involved sites. Risk-adapted, combined-modality therapy using only four cycles of VAMP chemotherapy with 15 to 25.5 Gy of involved-field radiation for patients with early-stage/favorable Hodgkin's disease is highly effective and without demonstrable side-effects. These results indicates that patients with stages I and IIA, non-bulky, and involving less than three Ann Arbor sites can be cured with limited therapy that does not include an alkylating agent bleomycin, etoposide, or high-dose extended-field radiation therapy

Comparative study of TL-201 WBS, TC-99M MIBI WBS and serum TG versus 1-131 WBS in cases of well differentiated thyroid carcinoma

Between January 2000 and December 2001, 60 patients with well differentiated papillary and follicular carcinoma of thyroid gland were followed up. It was found that the destruction or dedifferentiation of thyroid malignant cells caused the failure of the accumulation of I-131 leading to false negative iodine-131 scintigraphy, this was not true with Tl-201 or Tc-99m MIBI. Serum thyroglobulin [Tg] was considered as the gold standard of the presence of residual, recurrence or metastatic lesions in this study. It was found that patients with serum Tg level more than 10 ng/ml had a residual, recurrent or metastatic disease, while patients with serum Tg level<10 ng/ml had no recurrence. Tl-201 WBS, Tc-99m MIBI WBS and serum Tg levels were done in cases with negative I-131 scintigraphy, i.e. 46 patients. All the patients with negative 1-131 scintigraphy were found to be positive by either Tl-201 WBS or Tc-99m MIBI WBS. Tc-99m MIBI or TL-201 scintigraphy has an important role in detection of recurrent or metastatic patients with well-differentiated thyroid carcinoma if I-131 scan is negative and Tg level is elevated as either or both of them were positive in all false negative cases